Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: The STOP-NIDDM
Chiasson J-L, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M for The STOP-NIDDM
Trial Research Group.
The STOP-NIDDM trial was one of several pointing to the importance of post-prandial glucose values, which have until recently received less attention than fasting glucose.
In a subanalysis of the STOP-NIDDM trial, acarbose slowed the progression of intimal-medial thickness in subjects with IGT, the first placebo-controlled, prospective study to show that counterbalancing of postprandial hyperglycemia may be vaso-protective (Stroke 2004;35: 1073-8).
was one of several recent studies pointing to the importance of postprandial glucose values, which have until recently received less attention than fasting glucose.
In a subgroup analysis restricted to the one-quarter of STOP-NIDDM
participants at highest cardiovascular risk according to Framingham risk score, prescribing acarbose routinely in such a population would actually save a health care system money.
STUDY KEY Abbreviations of studies mentioned in this article ACCORD Action to Control Cardiovascular Risk in Diabetes study ADVANCE Action in Diabetes and Vascular Disease study DIGAMI 2 Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction study HEART2D Hyperglycemia and Its Effect After Acute Myocardial Infarction on Cardiovascular Outcomes in Patients With Type 2 Diabetes study NHANES National Health and Nutrition Examination Surveys ORIGIN Outcome Reduction With Initial Glargine Intervention trial STOP-NIDDM
Study to Prevent Non-Insulin- Dependent Diabetes Mellitus trial VADT Veterans Affairs Diabetes Trial UKPDS United Kingdom Prospective Diabetes Study
Reduced Risk of Type 2 Diabetes, Relative to Placebo in STOP-NIDDM
Subgroups Fasting insulin of 65 pmol/L or less 45% Smokers 39% Normotensive 33% BMI less than 30 kg/[m.
The efficacy of metformin relative to placebo was more marked in younger patients, those with a higher body mass index, men, and those with a higher baseline fasting blood glucose-a quite different profile than for those who tended to do best with acarbose in STOP-NIDDM
The results conflict with the shorter-duration STOP-NIDDM
study, which found that after an average of 3 years, 32% of treated patients had diabetes, compared with 42% of placebo-treated patients (Lancet 2002; 359:2072-2077).
Chiasson JL, Josse RG, Gomis R, Hanefield M, Karasik A, Laasko M; STOP-NIDDM
Trial Research Group.
Trial: an international study on the efficacy of an alpha-glucosidase inhibitor to prevent type 2 diabetes in a population with impaired glucose tolerance: rationale, design, and preliminary screening data.